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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: yZa~ ~,~~.~ Date: ~ -~_ q~ <br />NPDE S ID. No.:CO-0000213 005 Date Last Inspected : (,_ ~~_q~ <br />Faci lity Configuration:Side Hill Pond <br />Site Name: Impoundment #005 Location:97N16W36AD <br />Mine Name: New Horizon Mine Location:2 mi.NW of Nucla. CO. <br /> <br />Mine ID No.: CMLRD Permit #0008-81 <br />Owne rs Rep.: R. L. Wade. Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE R ESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) Q No N/A <br />2. Lift thicY,ness !inches) _ <br />3. Compaction according to approved plan ~e No N/A <br />4. Burning (specify extend and location) Yes ~ T]/A <br />5. .Angle of slope: 3:1 upstream, ?:1 downstream _ <br />6. Seepage (specify location, color, antl appror.. volume) <br /> a.) From unde rd rain pipes: Yes ~ N/A <br /> b.) At isolated points on embankment slopes: Yes ® N/A <br /> c) At natural hillside: Yes Q,@, N/A <br /> d) Over widespread areas Yes ~, N/A <br /> e) From downsteam foundation area Yes ®, N/A <br /> f) "Boils" beneath stram or pond ed water Yes 0° N/A <br />7. Cracks or scarps on crest Yes ~dy N/A <br />8. Cracks o- scraps en slope Yes ~ N/.A <br />9. Sloughing or bulging on slope Yes ® N/A <br />10. Major erosion problems Yes ~~ N/A <br />11. Surface mOVemonts in valley bottom or on hillside Yes ® N/A <br />12. Erosion of toe Yes ~ N/A <br />13. Water impounded against toe Yes ~ ® R/A <br />19. Existing embankment freeboard (feet) t Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes ® N/A <br />16. Visible sumps or sin Y.holes in slurry surface Yes ~ N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes 1~ N/q <br /> b) Decant system Yes ~o N/A <br /> C1 Diversion Ditches Yes ® N/A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes .@, N/A <br /> b) Decant system Yes ® N/A <br />19. Trash racks clear and in ~ No N/A <br />Troce O~ ~~r In ~pp{~ou, <br />c: \data\wpdata\damform.doc <br />~/-~~ <br />